Adherence to treatment in patients with open-angle glaucoma and its related factors

Authors

  • Mohsen Adib-Hajbaghery Professor, Ph.D., Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran

Keywords:

Open-Angle Glaucoma, Adherence, Medication, Related factors

Abstract

Introduction: Lack of adherence to medical treatments typically lead to burdensome consequences such as progressive visual impairment, blindness, and disabilities. This study aimed to determine the adherence to medication in patients with open-angle glaucoma and related factors in patients referred to the Matini Ophthalmology Hospital in Kashan, Iran. 

Methods: A cross-sectional study was conducted from 23 July 2015 to 20 January 2016 on all patients with open-angle glaucoma referred to the Matini Ophthalmology Hospital in Kashan, Iran. A questionnaire was used to gather data about patients’ demographics and factors affecting adherence to medical treatments. The Morisky Medication Adherence Scale was used to evaluate the adherence to glaucoma medication. Results were analyzed using SPSS version 13. Descriptive statistics, chi-square, and logistic regression analysis were used. 

Results: In total, 130 patients with a mean age of 55.36 ± 15.54 were studied. Only 34.6% of patients completely adhered to glaucoma medications. The chi-square test showed that age (p=0.007), education (p=0.01), life entourage (p=0.04), place of residence (p=0.06), average monthly income (p=0.005), the interval between medical visits (p=0.007), problem in scheduling the medical visits (p<0.001), number of medications (p<0.001), lifelong using and side-effects of medications (p<0.001), answers of the physician to the patient’s questions (p<0.001), financial and traveling problems (p<0.001), lack of skill in using eye drops (p<0.001), lack of awareness of glaucoma complications and symptoms (p<0.001), forgetting, fatigue, impatience, believing in uselessness of medications, and lack of support from family (p<0.001) were associated with patients’ adherence. Logistic regression showed that 89% of variance of patients’ adherence to glaucoma medications can be predicted by seven factors: problems in traveling and scheduling medical visits, the large number and side effects of medications, impatience, forgetting, and lack of skill in using eye drops. 

Conclusion: About two-thirds of patients with open-angle glaucoma did not adhere to their own medications. Appropriate patient education and planning a patient follow-up strategy might positively affect the patients’ adherence to glaucoma medications.

References

American Academy of ophthalmology. Primary open-angle glaucoma-Europe. 2013. Available from:

http://www.aao.org/topic-detail/primary-openangle-glaucoma--europe

Lu VH, Goldberg I, Lu CY. Use of glaucoma medications: state of the science and directions for

observational research. Am J Ophthalmol. 2010; 150(4): 569-74.e9. doi: 10.1016/j.ajo.2010.05.005. PMID:

Amini H, Javadi M, Pakravan M, Karimian F, Velaei N, Rezaei A, et al. The prevalence of glaucoma in

people over 40 years living in Tehran. Bina J Ophthalmol. 2003; 9(1): 3-13.

Masumi R, Masumiganjgah A, Ojaghi H, Banazadeh E. Prevalence of visual impairment in adult's patient

over 40 years old in Alavi hospital during 2005-6. J Ardabil Univ Med Sci. 2012; 12(2): 166-72.

Nordmann JP, Denis P, Vigneux M, Trudeau E, Guillemin I, Berdeaux G. Development of the conceptual

framework for the Eye-Drop Satisfaction Questionnaire (EDSQ) in glaucoma using a qualitative study.

BMC Health Serv Res. 2007; 7: 124. doi: 10.1186/1472-6963-7-124. PMID: 17683594, PMCID:

PMC1973077.

Konstas AG, Maskaleris G, Gratsonidis S, Sardelli C. Compliance and viewpoint of glaucoma patients in

Greece. Eye (Lond). 2000; 14 Pt 5: 752-6. doi: 10.1038/eye.2000.197. PMID: 11116698.

Sabate E. Adherence to long-term therapies, evidence for action: World Health Organization. 2003.

Available from: http://www.who.int/chp/knowledge/publications/adherence-full-report.pdf.

Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM. Persistence and adherence with

topical glaucoma therapy. Am J Ophthalmol. 2005; 140(4): 598-606. doi: 10.1016/j.ajo.2005.04.051.

PMID: 16226511.

Schwartz GF, Quigley HA. Adherence and persistence with glaucoma therapy. Surv Ophthalmol. 2008; 53

Suppl 1: 57-68. doi: 10.1016/j.survophthal.2008.08.002. PMID: 19038625.

Olthoff CM, Schouten JS, van de Borne BW, Webers CA. Noncompliance with ocular hypotensive

treatment in patients with glaucoma or ocular hypertension an evidence-based review. Ophthalmology.

; 112(6): 953-61. doi: 10.1016/j.ophtha.2004.12.035. PMID: 15885795.

Tamrat L, Gessesse GW, Gelaw Y. Adherence to topical glaucoma medications in Ethiopian patients.

Middle East Afr J Ophthalmol. 2015; 22(1): 59-63. doi: 10.4103/0974-9233.148350. PMID: 25624675,

PMCID: PMC4302478.

Ung C, Zhang E, Alfaro T, Murakami Y, Zhang M, Seider MI, et al. Glaucoma severity and medication

adherence in a county hospital population. Ophthalmology. 2013; 120(6): 1150-7. doi:

1016/j.ophtha.2012.11.026. PMID: 23453512, PMCID: PMC3674151.

Heydari F, Shenasi A, Akbari R. The continuation of treatment adherence in patients with glaucoma and

glaucoma clinic Nikoukari Hospital Tabriz. Med J Tabriz Univ Med Sci. 2012; 34(5): 24-7.

Welge-Lussen U, Weise S, Yu AL. Assessing the adherence behavior of glaucoma patients to topical eye

drops. Patient Prefer Adherence. 2014; 9: 17-23. doi: 10.2147/PPA.S69943. PMID: 25565780, PMCID:

PMC4274150.

Yu AL, Weise S, Welge-Lussen U. Intensity of side effects of topical glaucoma medication and its

influence on adherence behavior in patients with glaucoma. Clin Ophthalmol. 2014; 8: 1221-6. doi:

2147/OPTH.S62494. PMID: 25061268, PMCID: PMC4085302.

Sleath B, Blalock SJ, Covert D, Stone J, Skinner AC, Muir KW, et al. Patient race, reported problems in

using glaucoma medications, and adherence. ISRN Ophthalmol. 2012; 2012: 902819. doi:

5402/2012/902819. PMID: 24558595, PMCID: PMC3914256.

Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of

medication adherence. Med Care. 1986; 24(1): 67-74. PMID: 3945130.

American Academy of Ophthalmology. Basic and clinical science cours. 10nd, editor. Singapore, Roy

Wilson. 2012.

Newman-Casey PA, Robin AL, Blachley T, Farris K, Heisler M, Resnicow K, et al. The most common

barriers to glaucoma medication adherence: a cross-sectional survey. Ophthalmology. 2015; 122(7): 1308- 16. doi: 10.1016/j.ophtha.2015.03.026. PMID: 25912144, PMCID: PMC4485580.

Mowatt L, Nelson-Imoru J, Gordon-Strachan G. Glaucoma medication compliance issues in a Jamaican

hospital eye clinic. West Indian Med J. 2011; 60(5): 541-7. PMID: 22519230.

Abu Hussein NB, Eissa IM, Abdel-Kader AA. Analysis of factors affecting patients’compliance to topical

antiglaucoma medications in Egypt as a developing country model. J Ophthalmol. 2015; 2015: 234157. doi:

1155/2015/234157. PMID: 26167292, PMCID: PMC4488247.

Cook PF, Schmiege SJ, Mansberger SL, Kammer J, Fitzgerald T, Kahook MY. Predictors of adherence to

glaucoma treatment in a multisite study. Ann Behav Med. 2015; 49(1): 29-39. doi: 10.1007/s12160-014- 9641-8. PMID: 25248302, PMCID: PMC4336606.

Stryker JE, Beck AD, Primo SA, Echt KV, Bundy L, Pretorius GC, et al. An exploratory study of factors

influencing glaucoma treatment adherence. J Glaucoma. 2010; 19(1): 66-72. doi:

1097/IJG.0b013e31819c4679. PMID: 20075676, PMCID: PMC2808197.

Hinkle J, Cheever K. Study Guide for Brunner & Suddarth's Textbook of Medical-Surgical Nursing. 13th,

editor. China: Lisa McAllister. 2014.

Published

2022-03-07